5 Common Misdiagnoses
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Fitness

5 Common Misdiagnoses

When aches and pains send you to the doctor's office, you probably don't question the diagnosis. But physicians can be wrong. Up to 15 percent of patients are misdiagnosed, research in the American Journal of Medicine revealed. And more than 150,000 people in the United States suffer preventable harm from an inaccurate diagnosis every year, according to a newly released estimate from Johns Hopkins University School of Medicine. We asked MD's we trust to tell us which conditions they often see misunderstood and mislabeled in active women. Here are five common mix-ups docs make -- plus how to finally get the right Rx so you can feel better fast.

Not Quite Right

You have an urgent need to pee all the time, and when you go, it's uncomfortable. This happens a lot.


Misdiagnosis: Urinary tract infection
What it really is: Painful bladder syndrome (interstitial cystitis)

With this chronic condition, the tissues of the bladder wall become inflamed, resulting in pelvic pain and the same symptoms as a urinary tract infection. However, unlike a UTI -- a bacterial infection that can be brought on by sex or an errant bathroom-visit wipe -- the cause of PBS is unknown. "UTIs are more common, so a lot of doctors misdiagnose the problem over the phone and just call in a prescription for antibiotics," says Charles Ascher-Walsh, MD, the director of gynecology at the Icahn School of Medicine at Mount Sinai in New York City. The anti-inflammatory effects of the antibiotics may make you feel better temporarily if you have PBS, but they'll never clear up the real condition. On average, it takes about four years before a correct diagnosis is made.

The fix: "When you have repeat UTIs, you need to see your doctor for an exam and additional tests," Dr. Ascher-Walsh advises. Be sure to tell him how often symptoms occur as well as what seems to cause and relieve them. If he determines you have PBS, he may prescribe a medication like Elmiron, which is believed to help replenish damaged areas of the bladder wall; a tricyclic antidepressant like amitriptyline to treat the chronic pain; and/or a bladder bath, a procedure in which the doctor uses a catheter to coat your bladder with a cocktail of meds to suppress inflammation. For at-home pain relief, try soaking in a warm bath or placing a heating pad on your achy pelvis. Drinking a glass of water with a teaspoon of baking soda, which lowers urine's acidity, can also help. Some women find that certain foods and drinks spark or worsen their symptoms. "Eliminate the most common culprits: anything with caffeine -- including chocolate -- or carbonation as well as citrus and other vitamin C-rich foods," Dr. Ascher-Walsh suggests.

The inside of your ankle hurts when you run or walk, and it looks a little red and swollen.


Misdiagnosis: Ankle strain or sprain
What it really is: Excessive foot pronation

With normal pronation, after your heel strikes, your foot rolls inward until it's flat on the ground. Then, when you push off to take a step, your weight shifts to the front inside of your foot and the big-toe joint. Overpronators, however, continue to roll farther to the inside as they shift their body weight. This motion puts strain on the tendons and ligaments around the ankle, causing pain that can be dull and achy at times and sharp at others.

The fix: Many specialty running stores do gait analysis, which captures your foot motion on camera as you run and indicates whether you overpronate. You can also look at the bottom of your running shoes or everyday flats to check the wear pattern: If the heels are more worn down on the inside edge, tilting inward toward the arch, you're rolling in too far with each stride. "Try orthotics or arch supports to limit pronation," says Joe Ellis, a podiatrist and the author of Running Injury-Free. Also, choose stability shoes for your workouts and whenever possible wear casual and dress shoes with firm backs for maximum support.

 
You wheeze, cough, can't catch your breath, and feel fatigued when you exercise.

Misdiagnosis: Bronchitis
What it really is: Exercise-induced asthma

EIA is a no-brainer for your doc to ID if your symptoms stop when your workout ends. It gets tricky, though, if you have signs only once in a while or if the cough and fatigue last for days, which is especially common if you have allergies.

The fix: Tell your doctor about the onset and severity of symptoms, how long they last, what aggravates or alleviates them and how hard you work out. Ask her for a pulmonary function test with a methacholine challenge, which measures your lung capacity and rate of airflow, says Robert W. Jones Jr., MD, an internist and a quality-review officer at the Cleveland Clinic Medicine Institute. Although EIA is a chronic ailment, symptoms usually improve with gradual cardiovascular conditioning and the avoidance of potential triggers, such as exercising outdoors in cold weather or where there's heavy air pollution, working out on days when the pollen count is high, and swimming in chlorinated pools. You may need to puff on a quick-relief inhaler to open your airways before and sometimes during your workout. Check with your physician.

More Common Misdiagnoses

You're dizzy and weak during exercise. Whoa, you almost fainted!

Misdiagnosis: Dehydration
What it really is: Low blood sugar (hypoglycemia)

It's easy for doctors to mistake hypoglycemia for dehydration in active people. Dehydration is more common, and it can trick you into thinking you're hungry. With either condition, you feel better after downing juice or a sports drink, but if your blood sugar is low, it's the sugar, not the hydration, that helps. "There's a mistaken belief that healthy people with a normal sugar metabolism cannot exercise to the point of low blood sugar, but they can," Dr. Jones says.

The fix: Keep a food and exercise diary and give your doctor a detailed history of your diet, fluid intake, and workout habits. To avoid episodes, stabilize your blood sugar by eating a snack with protein and fat, such as a banana with peanut butter, two hours before exercising. Also, sip a sports drink or energy gel every 20 to 45 minutes during workouts that last longer than an hour, Dr. Jones advises.

You're feeling moody and anxious, you can't focus, and you just want to take a nap. You've also gained weight.

Misdiagnosis: Depression
What it really is: Underactive thyroid (hypothyroidism)

When the thyroid gland doesn't produce enough hormones, bodily functions slow down, making you feel sluggish and irritable. "I see this as having been misdiagnosed as depression in many patients who come to me," says Robert McConnell, MD, an endocrinologist at New York Presbyterian Hospital/Columbia. Hypothyroidism can begin in your twenties and thirties, and it occurs after 15 to 20 percent of pregnancies, when it may be mistaken for postpartum depression. Other symptoms include increased sensitivity to cold, thinning hair, dry skin, and constipation. Your general practitioner may run only the most basic thyroid test, which isn't always accurate.

The fix: See an endocrinologist, who will conduct more sensitive tests to determine your levels of thyroid-stimulating hormone (TSH) and another hormone called T4. Ask her to also check your levels of free T3, free T4, total T3, reverse T3, antithyroid antibodies, and sex hormone-binding globulin (SHBG). These help diagnose a low-functioning thyroid, which is often missed by many physicians, according to the National Academy of Hypothyroidism. The condition is typically treated with thyroid hormone-replacement meds, and it takes several months for symptoms to improve.

Find Out What's Really Wrong, Stat!

"Lack of time, the misguided use of technology, and poor communication are often to blame for misdiagnoses," says Robert W. Jones Jr., MD, an internist at the Cleveland Clinic Medicine Institute. Take these steps to keep mix-ups to a minimum.

Choose a doctor who spends a lot of time with you.
If your MD is overbooked, he's more likely to make a hasty call, Dr. Jones says. Search for a new one on Zocdoc.com, where you can check out reviews from other patients.

Step away from Google.
A 2012 Pew Research Center study found that 40 percent of women self-diagnosed online, and then 55 percent of them followed up with a doctor. That's dangerous because you may report only the symptoms that confirm your own assumptions. Keep a diary of all your symptoms, make a list of questions, and bring both to your appointment.

Don't skip follow-up visits.
"Doctors often need to monitor symptoms and try different treatments to make a correct diagnosis," Dr. Jones explains. "Make sure your physician is asking appropriate, probing questions about your problem and how you're responding to treatment, as well as listening to your answers and explaining the next steps in a way you understand." Don't be shy about speaking up if what he's telling you doesn't seem quite right.

Originally published in FITNESS magazine, May 2013.

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